Metastases

Extraneural metastasis of primary CNS tumors is an unusual but well recognized phenomenon. Medulloblastoma is the most common of the neural malignancies reported to spread in this way, although germinoma and astrocytoma are also well described. Lymphatic and hematoge-nous pathways are the most likely routes of spread; however, whether or not shunt systems provide a potential conduit for tumor spread has given cause for concern. Indeed, the incorporation of filters into shunt systems has been advocated to diminish the risk of this. In an analysis of 160 published cases of extraneural spread of medulloblastoma, Jamjoom et al. [28] suggested that the shunt could be implicated in no more than 11 patients. In a further eight cases of extraneural spread in a series of 415 intracranial tumors, Berger et al. [29] failed to identify any increased risk attributable to the presence of a shunt device.

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.